The Pelvic Floor Questionnaire

I have written a number of blogs now on the pelvic floor area. Many of you might be asking yourselves whether it is this really that important, or thinking “this may apply to others but I am fine now and therefore I do not need to do my pelvic floor exercises”. However, yes this does apply to you; even if you suffer no problems at the moment, it can prevent future problems, so start exercising today. I have made a pelvic floor questionnaire that will help you determine whether you are a high risk or lower risk for future problems developing. If you find yourself in the higher risk category, which applies if you answer yes to any of the following questions, then you might find it worthwhile spending a session with a physio to ensure you are doing the exercises correctly. So here we go.

1. Do you suffer with your waterworks i.e. do you leak urine when you cough, sneeze or do exercise (stress urinary incontinence) or get a desperate urge to go and not make it to the toilet in time (urge incontinence)?

Facts

Up to 1 in 3 women will leak urine during their lifetime. Women under the age of 50-55 tend to suffer from stress urinary incontinence while post menopausal women tend to suffer from urge incontinence. However you can suffer from both regardless of your age.

2. Do you have a pelvic organ prolapse? (a bladder prolapse, cystocele, uterine prolapse, the womb, or bowel, rectocele, or a combination of any of these.)

Facts

1 in 2 women will develop a pelvic organ prolapse and women with a prolapse are 3 times more likely to suffer from urinary incontinence.

3. Have you had a normal vaginal delivery?

Facts

10% of women will have damage to their pelvic floor muscles after a vaginal delivery. After a normal vaginal delivery you are at double the risk of developing a prolapse. The risk increase if you have a big baby (over 4kg) or twins.

4. Did you have an instrumental delivery, either ventouse or forceps?

Facts

25% of women whose babies are delivered by ventouse will sustain pelvic floor damage, 65% for forceps.

5. Did you have a prolonged second stage of labour?

Facts

This is associated with neuromuscular damage to the pelvic floor.

If you are suffering from incontinence or not sure if you are doing your pelvic floor exercises correctly and would like to book an appointment, please contact me on 0544485086 or by email to tamaramay.physio@gmail.com. I can arrange to see you in Bishvilaych Women's Comprehensive Medical Centre in Givat Shaul, Jerusalem or a home visit if you live in Gush Etzion.

Prolapse: Don't Let It Be Your Downfall

One in two women will develop a prolapse, but again this is one of those secrets that is never spoken about and therefore often never dealt with. Strengthening your pelvic floor muscles and making some lifestyle changes can reduce or resolve symptoms of a pelvic organ prolapse.

A pelvic organ prolapse is when either the bladder, bowel or womb bulges into the walls of the vagina which have often been weakened through various stages of life, such as pregnancy, birth and menopause, as well as chronic constipation and jobs involving heavy lifting. This may or may not be accompanied by symptoms. However, if you feel a lump, or a bulge in the vagina, or as if something is there or something has come down, or you get an aching, dragging feeling if you have been on your feet all day, then it can really affect the quality of your life. It can also cause urinary and bowel symptoms or make you feel uncomfortable during sex.

The pelvic floor muscle has two roles. One is to help with toileting and the other is to support your bladder, bowel and uterus. With a prolapse, the muscle fibres that need to be strengthened are the endurance ones. Therefore they are constantly working. If you brace your pelvic floor muscles every time you are lifting this can help strengthen them. Ideally if you have been diagnosed with a prolapse then you should avoid lifting heavy objects.

One way of dealing with a prolapse is surgery, but it is not always the best option and you should always first try a more conservative approach - which often produce very good results and avoid the need for surgery entirely. Your women's health physiotherapist can show you suitable exercises and other treatments, and suggest appropriate lifestyle changes.

If you have a prolapse and would like to book an appointment, please contact me on 0544485086 or by email to tamaramay.physio@gmail.com. I can arrange to see you in Bishvilaych Women's Comprehensive Medical Centre in Givat Shaul, Jerusalem or a home visit if you live in Gush Etzion.

Exercise After a C-Section

Getting the right balance after a C-section is extremely important. Your body needs to recover and rest is very much needed. Rest whenever you get the opportunity in the first 4-6 weeks. Whenever the baby is sleeping, forget the housework and take a nap too (and anyone who knows me personally will know that me saying forget the house work is not something to be taken lightly.)

Eventually your body will start to feel like yours again and exercise can help the healing process along. A good form of general exercise is walking, starting with as little as 5-10 minutes daily and gradually building the time up to 30-40 minutes over the first 2 months.

Your lower trunk will also need to be strengthened and stabilised. This includes pelvic floor muscle exercises - which should not be forgotten by any women, not just those who are post c-section. Pelvic floor exercise should be carried out at least 3 times a day. Holding a contraction for 10 seconds and doing 10 reps of these, and also doing a quick contraction with a quick release also doing 10 reps of these.

Transversus abdominal exercises are another main area to focus on, (which includes pelvic tilts).

Lie on your back with your knees bent and feet flat on the bed. Pull in your tummy and tilt your pelvis up, flattening out the lower back. Hold this position for 2-3 seconds and then slowly relax half way. Continue tilting your pelvis up and relaxing to the half way position. Aim for the movement to be slow and smooth.

If you are suffering from any pain and would like to book an appointment, please contact me on 0544485086 or by email to tamaramay.physio@gmail.com. I can arrange to see you in Bishvilaych Women's Comprehensive Medical Centre in Givat Shaul, Jerusalem or a home visit if you live in Gush Etzion.

Labouring with SPD: The Birth Plan

Making a birth plan is important in my opinion (even if you don't stick to it) and this is even more true if you suffer from SPD. In a midwife's ideal world there would be no pregnancy complications and everyone would deliver on their backs in stirrups, so that the midwife could maintain a good posture and control the baby easily. In many patients' ideal world they would deliver in a more upright position so gravity could help the labour and delivery along. By making a birth plan, you can consider all the different options and factors and work our what your preferred labour would look like.

If you suffer from SPD it is important before labour begins to measure how far you can open your legs in a pain free range. If your are very prepared you can buy a long piece of rope and tie it around your knees so you have the measurements of how far you are going to allow your legs to be open during the delivery, on hand. This is even more vital if you plan on having an epidural. This is because you will not feel pain while the epidural is in but will feel the pain afterwards if you have opened your legs into your pain range. With this in mind, a position that should definitely be avoided is a delivery in stirrups.

In the first stage of labour, movement and gravity play an important role. Most commonly, at this stage you are still at home, and timing your contractions. If you suffer from SPD it is still good to be walking around but not to be constantly climbing the stairs, which can often speed things along. Using the gym ball can also be good, by sitting on it and rolling your pelvis, but do ensure that your legs are not straddled too far open.

It is important to support your body in positions that are comfortable for you but to avoid straddling your legs, for example do not straddle a chair, however you can lean onto a chair or any other equipment.

In the final pushing stages there are many good options for positions. Being on your side is very good because the midwife can have good control and you can too. You can also be in a squatting position (as long as you are in pain free range). Any position where your legs are in your control and cannot be pushed open by someone else is a good position.

If you are suffering from SPD and would like to book an appointment, please contact me on 0544485086 or by email to tamaramay.physio@gmail.com. I can arrange to see you in Bishvilaych Women's Comprehensive Medical Centre in Givat Shaul, Jerusalem or a home visit if you live in Gush Etzion.